If your baby makes noises when breathing, take note of what they sound like. This will help determine if and where there is a problem in the breathing passages.

Whistling noise: A small blockage in the nostrils tends to make a whistling noise that stops when the blockage is cleared. Newborn babies breathe out of their noses, not their mouths. This is a good trick, as it allows them to breathe and eat at the same time. However, their little noses have small air passages, so a little bit of mucus or dried milk can make the breathing passage even smaller, causing a whistling noise or occasionally, difficulty moving the air in and out.

Hoarse cry and a “barking” cough: A blockage in the larynx or windpipe, often due to mucus, makes a hoarse cry and a barking cough. This may be due to croup.

Deep rasping sound: Any narrowing in the trachea (which is in the neck) makes a deep rasping sound during breathing. This sound is rarely due to a blockage since the trachea is pretty big. More often it is caused by a condition called tracheomalacia, in which the tissues of the trachea are soft and flexible and make a noise when the infant breathes in and out. Usually this doesn’t cause significant trouble with breathing.

Deep cough: A blockage in the large bronchi (divisions of the trachea, which lead into the lungs) makes a deep cough.

Whistling sound ( wheezing): A blockage in the bronchioles (small airways that come from the bronchi) makes a whistling sound when the infant breathes in and out, as in bronchiolitis or asthma.

Fast, laboured breathing: Fluid in the smallest airways (the alveoli) causes pneumonia, an infection due to a virus or bacteria. Pneumonia causes fast, laboured breathing, occasionally cyanosis (see below), a persistent cough, and crackly sounds when listened to with a stethoscope.

Tips for concerned parents

Observe your baby’s breathing when he or she is well, so you can get used to how it looks and sounds. Time how many breaths they take in a minute. It’s probably faster than you imagined. Knowing what’s normal will help you spot a potential problem more quickly.

When in doubt, make a video of the breathing pattern that is worrying you to show to your doctor.

When to worry

Signs of potentially worrying breathing problems include:

Persistently increased rate of breathing: greater than 50-60 breaths a minute, or so

Increased work to breathe: signs of this include:

Grunting - the baby makes a little grunting noise at the end of respiration. This serves to try to open up blocked airways.

Retractions - the muscles in the baby’s chest (under the ribs) and neck are seen visibly going in and out much more deeply than usual.

Cyanosis: this means the blood is not receiving enough oxygen from the lungs (such as with pneumonia), so the skin acquires a blue colour. This will be especially apparent in areas that get a lot of blood flow, such as the lips, nails and tongue. Sometimes the hands and feet of newborns turn bluish, but the rest of the body is fine. This is not due to a lung problem but a common response to changes in temperature.

Lethargy: your baby’s energy level may be markedly decreased if he or she has a significant lung problem.

Fever: most infections of the lung will cause a fever as well. Always check your baby’s temperature when you are concerned.

Breathing problems (such as noisy breathing) that occur only occasionally rarely represent a concerning breathing problem. Worrying breathing problems, on the other hand, are usually persistent. However, when it comes to any breathing concerns, seek medical advice.

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